Wednesday, December 9, 1998 Published at 13:14 GMTHealthBreast cancer death rates publishedHospital performance is more closely scrutinised than everNHS performance indicators released by the Department of Health on Wednesday include details of death rates from breast cancer for the first time.

The change is the first step in government plans to provide more accurate measures of the effectiveness of treatment in hospitals.

Until now, the performance indicators have measured the time patients wait for treatment, but not how effective the treatment they receive has been.

It is the last year the tables will appear in their existing form before they are scrapped in favour of new "focused" lists covering specific hospital functions, including clinical results.

Mortality rates for a range of conditions will feature in the new lists, to be introduced as early as Spring 1999. Death rates have been published in Scotland since 1994.

These are likely to be divided into numbers of patients dying after being admitted for emergencies, such as hip fractures and heart attacks, and patients dying as a result of infected wounds.

Clincial outcomes are measured for the first time

Another set of indicators released last month compared the cost of hospital surgery and found that the cheapest hospitals operated for six times less than the most expensive.

An introduction to the latest figures explains why breast cancer mortality figures have been included.

"This will allow comparison over time of NHS performance in detecting and treating this disease."

The latest performance tables use an expanding list of indicators which include waiting times for accident and emergency departments, cancelled operations, hospital admissions and outpatient appointments. Complaints against hospitals are another new addition to this year's tables.

Dr Jonathan Michael is chief executive of the University of Birmingham NHS Trust. He said the tables should be interpreted with caution.

"It is very important that we recognise that the hospitals are delivering different forms of service to different groups of patients. Therefore comparing one to another is not always easy."

However, he welcomed the expanded set of performance indicators.

"Like any form of monitoring it is evolving, and I welcome the evolution of the tables.

"Some of the standards we are looking at here are welcome but they are never going to be absolutely perfect."

Complaints data

The Association of Community Health Councils for England and Wales said the tables had failed to take into account oral complaints from patients and made no attempt to gauge their seriousness.

Donna Covey, the group's director, said: "The variation between trusts in the number of written complaints they receive could be due to a number of factors and is not a reliable indicator of quality of service.

"The raw data presented does not indicate the ratio of complaints to patients. No indication of the seriousness of complaints is given.

New indicators are also included on care of the elderly, and delayed discharges of patients.

The star-rating system used in previous years has been dropped. It was supposed to show performance "at a glance" but was criticised as unfair.

Overall view

However, the Institute of Health Services Management said the tables gave a far from complete picture.

Christine Miles, a member of the institute's national council, said: "The current format is not about the quality of care nor do they reveal they whole story. The league tables do not compare like with like nor do they illustrate the local picture.

"A change in focus from quantity to the quality of patient care and treatment will hopefully give a truer picture of what is happening in the NHS."

She said that NHS managers faced an increased workload and the tables should reflect that.

The pressure to cut waiting lists could be hindering patients' access to care, Ms Miles added.

She said: "The figures indicate a drop in the number of outpatients seen after being referred for treatment by their GP.

"This suggests there is a greater pressure on hospitals to cut waiting lists. But it is the whole patient experience that counts."

'Out of date'

The NHS Confederation, which represents health service managers, said the performance tables are out of date as they reflect the current Patient's Charter, which is under review.

Stephen Thornton: "Meaningless tables"

Stephen Thornton, chief executive of the confederation, said: "It is generally accepted that these tables give the public only sweeping and meaningless judgements on the NHS.

"There is little sense in comparing statistics between, for example, a large acute teaching hospital and a small district general hospital serving a deprived community."

He said the confederation welcomed the end of this style of table and looked forward to a system "focused on outcomes that matter to the public and underpinned by a set of values for the NHS".